SEC Form 4 · accession 0001209191-15-048100
REVA Medical, Inc. · RVA:AX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Robert Bernard Stockman
Officer — Chairman and CEO · Director
Period of report
May 27, 2015
Accepted (ET)
May 29, 2015 · 7:18 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001496268
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | May 27, 2015 | A | 50,000 | $0.00 | A | 243,063 | D | |
| Common Stock | holding | — | — | — | 227,718 | I | By wife | |
| Common StockF2 | holding | — | — | — | 1,341,175 | I | Group Outcome Investors I, LLC | |
| Common StockF3 | holding | — | — | — | 1,101,615 | I | Kenneth Rainin Administrative Trust U/D/T 3/29/90 |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy)F4 | $3.90 | May 27, 2015 | A | 70,000 | A | — | May 27, 2025 | Common Stock | 70,000 | 70,000 | D |
Explanation of responses
- F1These restricted stock units vest in full on the earlier of (i) May 27, 2016 or (ii) immediately prior to commencement of the Issuer's next annual stockholder meeting.
- F2Represents shares held by Group Outcome Investors I, LLC. The members of Group Outcome Investors I, LLC are Isabel Stockman Trust, Martha Davis, Trustee; Hope Stockman Trust, Martha Davis, Trustee; Phoebe Stockman Trust, Martha Davis, Trustee; and Elizabeth Stockman Trust, Martha Davis, Trustee. Each of the members shares voting and dispositive power with respect to the shares. The trustees are children of Robert Stockman, our Chairman of the Board and Chief Executive Officer, and for Section 16 purposes, we have reported the full beneficial ownership of Group Outcome Investors I, LLC under Mr. Stockman's beneficial ownership. Mr. Stockman disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein.
- F3Mr. Stockman, along with Jennifer Rainin, is the trustee of the Kenneth Rainin Administrative Trust U/D/T 3/29/90 and has voting and dispositive power with respect to these shares. Mr. Stockman disclaims beneficial ownership except to the extent of his pecuniary interest therein.
- F425% of the option shares vest on May 27, 2016 with the remaining option shares vesting in 36 equal monthly installments thereafter.